This is a common question asked by patients when considering orthodontic treatment. The answer is isn’t straight forward.

Some cases can clearly be treated without any teeth being removed. Some cases, where the patient’s teeth are so crowded or their teeth are so full that they cannot place their lips together without strain need extractions in order to make space for the teeth and lips to sit in a straight and functional position.

Many people fall somewhere in between where their teeth a neither overly crowded or their lips are unable to close.

Arch Expansion / Arch Development

The alternative to extractions is expansion of the arches (sometimes called “arch development”). Expansion is a strategy that can clearly be used to create space but we need to ask the questions:

How much can we expand?

How much space do we obtain?

How much expansion should we do before the lips strain to cover the teeth or the gums are at risk of receding?

Expansion creates space but far less than you may think. Only about 1mm of space is created for every 3mm of expansion of the back molar teeth. Research into expansion beyond correcting cross-bites shows that although quite large expansion can be achieved, it invariably relapses back to within 2-3mm of the original dimensions. We therefore can only gain ~3mm of stable expansion which only creates about 1mm of space for reducing crowding – not much really!

Further, studies on the long-term results of orthodontic alignment show that crowded cases treated with posterior dental expansion are the least stable post treatment by far – 90% of cases show unsatisfactory alignment 10 years post-treatment

To Expand or to Extract?

Clearly most patients and orthodontists would prefer to avoid extractions if at all possible. The percentage of extractions in modern orthodontic practices in the USA, UK and Australia is about 20%.

However, in cases where:

The crowding is severe

Teeth are already damaged

The gums are receding

The patient’s lips are too full

The patient is an adult and has a jaw discrepancy that could have been treated without extractions as a child but now needs extractions

Extraction of teeth is likely to be required.

Consult an Orthodontist Expert

This is a decision made with careful assessment of the teeth, the facial pattern, any pathology, and the long-term best interests of the patient in mind and is used with the assistance of radiographs of the teeth and jaws and all the diagnostic skill and experience of a specialist orthodontist.

Be sure to have a full consultation with a specialist orthodontist before undertaking orthodontic treatment.